Kruger, William NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William Kruger Male
Date of Death Age If Veteran of U.S. Armed Forces,
4/15/2018 86 War or Dates Navy
1.,. Place of Death Hospital, Institution or
Z City, Town or Village Hadley,NY Street Address 7 Links Avenue
GManner of Death T Natural Cause —Accident _Homicide E Suicide —Undetermined n Pending
W Circumstances Investigation
in Medical Certifier Name Title
1'
Address
Death Certificate Filed r District Number I Register Number
City, Town or Village Hadley
®Burial Date Cemetery or Crematory
April 19, 2018 Pine View Cemetery
0 Entombment 1
Address
❑Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z ❑Removal and/or Held
and/or Address
NHold
0 Date Point of
O.
0 Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
4 407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
i- Remains are Shipped, If Other than Above
2 Address
CC
W.
II.
Permission is hereby granted to dispose of the human remains described above as indica .
Date Issued `
/ 52•)6/04egistrar of Vital Statistics .. ('
(signature)
District Number 7 5,8 Place r)-8, V1-1,12,Ze.,44
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 4/1 9/2(Mace of Disposition 21 Quaker Road Queensbury
(address)
Ill
Erie 51 -c 1
(section) (lot number) (grave number)
p Name of Se ' .n or Person in Charge of Premises Connie L. Goedert
Z / ��,,�1..pp (please print)
W Signature ' ., is Title Superintendent of Cemetery
(over)
DOH-1555(02/2004)